Stress fractures of the base of the metatarsal bones in young trainee ballet dancers

For this study, 150 trainee ballet dancers (80 males, 70 females) belonging to the ballet schools of the "Teatro Alla Scala" in Milan, aged between 10 and 21 years, were considered. From September 2005 to September 2007, the researchers retrospectively created a database in which they collected clinical examinations and imaging studies of the dancers.

19 dancers (9 males, 10 females) presented stress fractures in the base of the metatarsal bones. The average age of the patients was 16.4 years. In all of them the appearance of pain and/or discomfort was gradual, related to specific foot positions and increased training sessions.

In a range of 7 to 20 days, a standard radiograph was taken which in 11 patients was negative (grade 1-2), in 8 cases showed a cortical reaction (grade 3) and only in one case a stress fracture was observed (grade 4). Later, a MRI was performed, in which the stress fracture and intramedullary edema were evident.

All patients were treated non-surgically with rest and external shockwave therapy 3 to 5 times in one month, depending on clinical and anatomical factors, the age of the dancers, and the type of stress fracture. While the dancers followed the rest period, they were allowed to perform stretching and isometric exercises without weight support. Generally, this period lasted from 3 to 5 weeks after diagnosis. 

All dancers returned to full activities after an average time of 18 days (range 14-23 days) following the end of treatment (6.3 weeks from the onset of symptoms). Researchers believe that certain characteristics of foot architecture (pronated foot, lack of ankle plantar flexion, and over-pointed foot) and menstrual patterns or diet habits are the most important causes of metatarsal stress fractures in young dancers. 

Read the full article here.

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